Chronic Inflammation Flashcards
What is chronic inflammation
Response to injury with associated fibrosis
True or false: chronic inflammation causes tong term consequences
True - resolution is not complete as they are left with scarring
How does chronic inflammation arise?
- If acute inflammation is too severe to be resolved in a few days
- De novo
- Repeated attacks of acute inflammation
How may chronic inflammation arise de novo
- autoimmune conditions
- chronic infections
What 6 types of cells can be seen in chronic inflammation
- macrophages
- lymphocytes
- plasma cells
- eosinophils
- fibroblasts
- giant cells
In which type of inflammation are macrophages seen mostly in
Chronic
Why does chronic inflammation look variable
Due to the different types of cells present in different scenarios
What are the 3 functions of macrophages
- phagocytosis
- Antigen presenting to immune system
- synthesis or cytokines (TNF and interleukin) which control other cells and also complement components, blood clotting factors and proteases
Which type of pathogen do macrophages usually digest
Bacteria
What are macrophages derived from
Monocytes
What histological appearance do lymphocytes have
Large nucleus with little cytoplasms
What are the functions of lymphocytes
Immunological:
- activate B lymphocytes to differentiate and produce antibodies
- activate T lymphocytes which are involved in cytotoxic functions
What is the histological appearance of plasma cells
- can see golgi (needed for antibody production)
- open nucleus with chromatin in the peripheries
- can see the cytoplasm
What is the histological appearance of eosinophils
- pink vacuoles
- bi-lobed nucleus
What do plasma cells do
Differentiated from B lymphocytes into antibody producing cells
What is the function of eosinophils
Kill parasites
What is the function of fibroblasts
Make collagen
What are the 3 types of giant cells
- langerhans
- foreign body type
- touton
What are giant cells
Multinucleate cells made by the fusion of macrophages
Why do giant cells form
Due to frustrated phagocytosis - where macrophages cant phagocytose particles so fuse together
In which infection are langerhan cells most commonly seen in
TB
What type of necrosis is touton cells seen in
Fat necrosis
What is the histological appearance of langerhan cells
- horse shoe peripheral nucleus
What is the histological appearance of foreign body type cells
Multiple aggregates of nuclei and foreign bodies
True or false: chronic is specific
False
What type of cell is seen in chronic inflammation in rheumatoid arthritis
Plasma cells
What type of cells are most commonly seen in chronic inflammation in chronic gastritis
Lymphocytes
What are the 4 affects of chronic inflammation
- Fibrosis
- Impaired function
- Atrophy
- Stimulation of immune response
What affect of chronic inflammation is seen in chronic cholecystitis
- Fibrosis causing a yellow fibrotic wall of the gall bladder which is usually translucence
- the gall stones produced cause repeated obstruction of the bile duct leading to chronic inflammation which causes fibrosis
What is experienced in chronic cholecystitis
Pain
What is an idiopathic disease
A disease where the cause is not known
What type of inflammation is present in imflammatory bowel disease
Both acute and chronic inflammation
What is the cause of inflammatory bowel disease
Not know - it is idiopathic
What do patients with inflammatory bowel disease present with
Diarrhoea, rectal bleeding (as inflammation damages mucosa)
What are 2 examples of diseases which are inflammatory bowel diseases
- ulcerative colitis
- Crohn’s disease
What is the difference between ulcerative colitis and Crohn’s disease
- Ulcerative colitis is superficial (the inflammation affects the mucosa only)
- Crohns is transmural (affects mucosa and deeper layers of the gut)
What is seen in Crohn’s disease
- strictures (fibrous borrowing)
- fistulae (abnormal connection between 2 mucosa lined organs)
What are common causes of cirrhosis
- alcohol
- hepatitis B and C
- drugs
- fatty liver disease
What happens to the liver function in cirrhosis
There is decreased liver function caused by chronic inflammation which is caused by various sources
The inflammation causes disorganisation of architecture
What is thyrotoxicosis
Hyperthyroidism (too much thyroid hormones produced)
What is Graves’ Disease
Where chronic inflammation causes hyperthyroidism as the antibodies produced by the immune system cause the production of more hormones
What is granulomatous inflammation
Chronic inflammation with granulomas
What is a granuloma
Group of macrophages and lymphocytes which stick together
When do granulomas arise
- hypersensitivity reactions
- persistent low levels of antigenic stimulation
What are the 3 main causes of granulomatous inflammation
- foreign material
- infection
- unknown causes
Give an example of an infection that causes granulomatous inflammation
TB
What organism causes TB
Mycobacteria which are difficult and slow to culture
What does TB cause
It causes disease by Persistence and induction of cell mediated response. Therefore there is chronic inflammation
What is seen in Tuberculous Granuloma
An area of caseous necrosis in the middle of the granuloma with langerhan cells nearby
What vaccine protects against TB
BCG
What happens during abnormal reactions to the BCG vaccine
BCG granulomas
Give 3 examples of granulomatous diseases of unknown cause
- sarcoidosis
- Crohn’s disease
- wegener’s granulomatosis
What organs does Wegener’s granulomatosis affect
Kidneys
What are the granulomas like in sarcoidosis
- variable
- non-caseating granulomas with giant cells
- involved in lymph nodes and lungs
What are the consequences of chronic inflammation
- fibrosis
- impaired function and atrophy
- stimulation of immune response
True or false: chronic inflammation is very heterogeneous
True - it is always variable
